Pre-frail Patients Research Articles

Is Frailty Discouraging Surgeons from Performing Thoracolumbar Fusion? A Retrospective Study.

Retrospective cohort study. To evaluate whether frailty scoring is associated with adverse outcomes and management of thoracolumbar fractures (TLF) patients. Trauma patients with TLF often face longer recovery. The Canadian Study of Health and Aging clinical frailty scale (CSHA-CFS) predicts outcomes in older trauma patients. Adult trauma patients admitted from 2017 to 2021 who presented with TLF were included. Frailty was scored using CSHA-CFS. Endpoints were in-hospital mortality, hospital length of stay, surgery, complications, and discharge disposition. Multivariate analyses adjusting for baseline characteristics were performed. P<0.05 was considered significant. Overall, 1456 patients were included; 1013 fit, 240 pre-frail, and 203 frail. Frail patients underwent fewer surgeries (OR=0.5 [0.32-0.77], P=0.002). TL fusion was associated with lower mortality (OR=0.31 [0.11-0.85], P=0.024). Pre-frailty and frailty were associated with increased risk of pneumonia (OR=2.522 [1.428-4.456], P=0.001; OR=2.93 [1.32-6.54], P=0.008, respectively) and death (OR=3.581 [1.853-6.921], P<0.001; OR=2.46 [1.07-5.67], P=0.035). Pre-frail and frail patients were more likely to discharge to skilled nursing facilities (OR=1.687 [1.024-2.780], P=0.04; OR=4.89 [2.66-9.0]), P<0.001). Pre-frailty and frailty were associated with poor outcomes and higher level of care at discharge. Frail patients were less likely to undergo TL fusion, despite its association with improved survival. This suggests frailty should not discourage surgeons from performing thoracolumbar fusion. Frailty scoring upon admission may help guide management and set realistic expectations for patients and their families.

Perioperative and frailty outcomes after total knee arthroplasty: a retrospective cohort study.

Total knee arthroplasty (TKA) is a common procedure with an increasing demand, especially among the elderly. Frailty is known to be associated with adverse perioperative outcomes in the older population. In this article, we aimed to understand the associations of preoperative frailty status and comorbid conditions in relation to their clinical and healthcare outcomes after TKA, and to describe the perioperative factors leading to improvement in a patient's frailty status after TKA. This is a retrospective cohort study, and the outcomes were assessed over 2 years. Frailty is defined by the Clinical Frailty Score. A total of 96 patient records were assessed, of which 13 (13.5%) patients were robust and 83 (86.5%) patients were prefrail or frail. Two years after TKA, the number of robust patients increased to 58 (61.7%) patients, showing a reversal of frailty in 48.2% of patients. Total knee arthroplasty in prefrail and frail patients is a safe procedure that leads to improvement of frailty status, with an increase in the proportion of patients becoming robust within 2 years after the operation.

Frailty assessment in patients with Behçet's syndrome: A cross-sectional monocentric study

AimsEvidence evaluating the association between pre-frailty and frailty, and risk of adverse health outcomes in patients with Behçet's syndrome (BS) is limited in the literature. The aim of this study was to characterize the prevalence of frailty and associated factors in a single-centre cohort of patients with BS. MethodsBased on the International Study Group's criteria, this was a monocentric cross-sectional study of BS patients. The Fried frailty criteria were used to define frailty. The Turkish version of the Behçet's Disease Current Activity Form was used to measure the disease activity of BS. Damage index was assessed with the Behçet's Syndrome Overall Damage Index. ResultsForty-four patients were enrolled. According to Fried frailty criteria, patients were classified as 13.6% frail, 59% pre-frail, and 27.2% robust, respectively. Compared to pre-frail and robust patients, frail patients had higher levels of inflammatory markers at the time of diagnosis. CRP levels at time of diagnosis and at the last visit were higher in the frail group than in the pre-frail and robust groups (p=0.039 and p=0.023, respectively). When active drugs for BS were evaluated, systemic glucocorticoid (50%, p=0.030) and cyclophosphamide (33.3%, p=0.006) treatments were higher in the frail group. ConclusionsFrailty and pre-frailty are commonly detected even in younger patients with BS. Inflammation can be described as potential determinants of frailty status.

Association of frailty with annual healthcare expenditures of older adults during cancer survivorship.

352 Background: Frailty contributes to healthcare expenditures. Cancer and its therapies can further increase or accelerate the rate of frailty. Addressing geriatric deficits contributing to frailty of older cancer survivors (ages 65+) could potentially reduce health expenditures. However, little is known about how frailty affects health expenditures during the continuing survivorship period, a period after initial treatment but before the end-of-life. Given that older adults with cancer can live for years, it is important to examine health expenditures during this period by levels of frailty. Methods: We used the 2-year longitudinal panels of the Medical Expenditure Panel Survey, a nationally representative survey, to identify cancer survivors who are likely in the continuing survivorship period. We created 5 cohorts who were surveyed in 2016, 2017, 2019, 2020, and 2021, and in the previous year. In each cohort, we selected older individuals with an invasive cancer diagnosis in both previous and current years who did not die in the current year. We pooled the cohorts to estimate annual healthcare expenditures, representing a cancer population of 11,802,386 in the US (n=2,206). We constructed a deficit accumulation frailty index using survey items and divided patients into 3 categories: robust, pre-frail, and frail. We used generalized linear regression to estimate the associations of frailty with annual healthcare expenditures during the continuing survivorship period for older adults, controlling for age, sex, race/ethnicity, marital status, immigration background, insurance coverage, family size, family income, and education. Costs were inflated to 2023 US dollars. Results: The per person annual healthcare expenditure among older adult survivors of all cancer types was $13499.13, $24698.77, and $34352.23 for those who were robust (75.2%), pre-frail (12.0%), and frail (12.8%), respectively, and being pre-frail and frail was associated with higher expenditures (P&lt;0.001). In analyses by cancer type, being frail (vs. robust) was associated with higher expenditures for bladder (P&lt;0.05), breast (P&lt;0.01), cervical (P&lt;0.01), and prostate (P&lt;0.01) cancers. Pre-frail breast cancer patients also incurred more costs than those who were robust (P&lt;0.01). Conclusions: Increased frailty was associated with higher annual healthcare expenditures among older cancer survivors during the continuing survivorship period. Addressing geriatric deficits and intervening to maintain function and prevent frailty progression during survivorship care could improve quality of life and reduce healthcare expenditures.

Effect of a Multicomponent Intervention on Pre-Frailty Status Changes in Patients Undergoing Maintenance Hemodialysis: A Randomized Controlled Study.

Aims/Background Pre-frailty is common in patients undergoing maintenance hemodialysis (MHD). Without proper management, it can quickly worsen and progress into frailty, leading to various adverse clinical outcomes. Therefore, timely interventions for pre-frail MHD patients are crucial. However, the response of pre-frail MHD patients to such interventions is currently unclear. This study evaluated the effect of a multicomponent intervention on changes in pre-frailty status, risk factors for frailty, quality of life, and clinical outcomes in pre-frail patients undergoing MHD. Methods Sixty MHD patients were randomly assigned to intervention (received a 12-week multicomponent intervention) and control (received standard care) groups, with 30 participants per group, between February and May 2018. Data were collected at baseline and at 3 and 9 months thereafter. Analyzed outcomes included changes in pre-frailty status, frailty risk factors (such as albumin level, pain, and anxiety), quality of life, and clinical outcomes during the follow-up period. Results Data from a total of 58 MHD patients were collected at three time points. At week 12, frailty scores were 0.9 points lower in the intervention group compared to the control group (p = 0.007). The intervention group showed a 26.2% higher proportion of patients who improved from pre-frailty to non-frailty compared to the control group (p = 0.029), and a 25.9% lower proportion of patients who progressed from pre-frailty to frailty (p = 0.021). Additionally, improvements in albumin levels, pain, anxiety, and quality of life were more significant in the intervention group (all p < 0.05). Although there were fewer incidents of falls and rehospitalizations in the intervention group during follow-up, these differences did not reach statistical significance (all p > 0.05). Conclusion This study validates the effectiveness and practicality of a multicomponent intervention in improving pre-frailty status, frailty risk factors, and quality of life in patients undergoing MHD. Clinical Trial Registration Chinese Clinical Trial Registry (ChiCTR-IOR-17012176).

Frailty assessment and outcomes in primary care for patients with diabetes during Ramadan: implications for risk evaluation and care plans.

Frailty is a critical concern for older adults, impacting their susceptibility to adverse events and overall quality of life. This study aimed to determine the frailty status of patients 60 years or older in Abu Dhabi Ambulatory Healthcare Services (AHS) and assess its relation to the stress exerted by Ramadan fasting and the occurrence of any adverse outcomes. In this prospective observational study, participants were included if the attending physicians used the IDF-DAR risk stratification assessment tool. A tele-interview was conducted to complete the FRAIL score within 6 weeks before Ramadan 1,444 (CE 2022). The outcome was assessed through another tele-interview and an electronic medical record review after Ramadan. According to the FRAIL assessment tool, among the 204 patients aged 60 years or older included in the study, 109 (53.4%) were classified as either frail or pre-frail. In total, 20 (9.8%) patients were frail, that is, 1 out of 10, and 89 (43.6%) were pre-frail. The remaining 95 (46.6%) patients were robust. Using logistic regression to assess the occurrence of adverse outcomes after Ramadan fasting, a higher frailty score was identified as the third independent risk factor [B = 0.4, OR = 1.5 (1-2.02-1.86), and p = 0.039] for experiencing an adverse event. The identified factors associated with frailty were age, increased albumin-to-creatinine ratio (ACR), chronic kidney diseases (CKDs), and ischemic heart diseases (beta = 0.27, p = 0.003; beta = 0.24, p = 0.004; beta = 0.2, p = 0.039; and beta = 0.18, p = 0.041, respectively). One-third of the frail patients had an event, while the incidence in pre-frail patients was 11.2%, and among the robust patients, the incidence was 6.3%. Physicians' global assessment of frailty did not align well with the structured FRAIL scoring. Only five (25%) out of the 20 patients identified as frail by the FRAIL assessment tool were also judged as frail or having cognitive function impairment by the physicians' global assessment tool. Frailty is prevalent among elderly patients with diabetes. Disparity exists between subjective and objective frailty assessments, emphasizing the need for standardized evaluation methods. Using the FRAIL tool is recommended for patients aged 60 or older with diabetes in Abu Dhabi.

Frailty among stroke patients and its effects on hospital outcomes

BackgroundAlthough assessment of frailty is increasingly being included in routine practice, its effects on hospital outcomes is not well studied. In this study, we used a national database to estimate the effects of frailty on hospital outcomes among stroke patients. MethodsThis study was a retrospective analysis of data from Nationwide Inpatient Sample (NIS) database collected during the years 2016 to 2019. Adult patients 45 years and older with a primary diagnosis of stroke were included for the analysis. Primary outcome was frequency of frailty among stroke patients. Secondary outcomes were in-hospital mortality, prolonged length of stay, mechanical ventilation, and acute renal failure. Frailty levels were assessed by using the Hospital Frailty Risk Score (HFRS). ResultsAmong 2,031,085 stroke hospitalizations, 362,140 (17.8 %) were non-frail, 1,333,000 (65.6 %) were pre-frail, and 335,945 (16.6 %) were frail. Regression analysis showed that the odds of mortality were significantly higher among frail (aOR, 2.82, 95 % CI: 2.63–3.04) and pre-frail (aOR, 1.62, 95 % CI: 1.53–1.73) patients, compared to non-frail patients. Similarly, the odds of mechanical ventilation were significantly higher among frail (aOR, 9.72, 95 % CI: 8.84–10.69) and pre-frail (aOR, 3.41, 95 % CI: 3.12–3.73) patients. The odds of acute renal failure were significantly higher among frail (aOR, 6.96, 95 % CI: 6.62–7.33) and pre-frail (aOR, 2.94, 95 % CI: 2.80–3.08) patients. ConclusionCollaborative efforts by neurologists, neurosurgeons, and physiatrists towards identifying frailty and incorporating it in risk estimation measures could help improve management strategies, resource utilization, and optimization of patient outcomes among frail stroke patients.

The impact of multidisciplinary geriatric follow-up on quality of life in older, non-surgical prefrail and frail patients with cancer [sbnd] A randomized controlled trial

IntroductionCancer management in older frail patients can be complex, given the high decline in functional status, comorbidity, and limited life expectancy affecting this group of patients. Therefore, this study aimed to investigate whether oncological treatment combined with comprehensive geriatric assessment (CGA) and tailored follow-up interventions improved or maintained quality of life (QoL) in older prefrail and frail patients with cancer. Materials and MethodsA single-center randomized controlled trial included participants aged 70 or older with head, neck, lung, upper gastrointestinal tract, colon, or rectum cancer referred to non-surgical treatment. All participants underwent CGA conducted by a multidisciplinary geriatric team in an outpatient oncological clinic. The team consisted of a geriatrician and a specialized nurse who provided tailored follow-up visits and phone calls within 90 days after randomization. Exclusion criteria were fit patients, referral for specialized palliative care, or participating in another geriatric research program. In patients with well-functioning cognition, QoL was assessed using the EORTC QLQ-C30 and QlQ-ELD-14 questionnaires before and after the intervention. In patients with cognitive impairment, the Overall QoL-Depression List was used. Changes in QoL were dichotomized into improved/unchanged or worsened and analyzed in a logistic regression model. ResultsIn total, 363 participants were included with a mean age of 76 years (SD 4.6) and 45 % were female. Sixty percent in the intervention group had improved or unchanged QoL compared to 66 % in the control group (odds ratio: 0.75 [95 % confidence interval(CI): 0.45–1.23]). Overall, clinically important changes were found in fatigue and reduced worries about the future. The intervention showed improvements in insomnia symptoms and reported decreased role functioning. Discrepancies were found in the burden of illness without a clinically important difference, where the intervention group experienced an increased burden while the control group had a decreased burden (coefficient: 9.02 [95 % CI, 0.49–17.5]). DiscussionMultidisciplinary geriatric follow-up did not universally improve QoL in older frail patients with cancer. However, positive changes in specific aspects of QoL revealed nuanced impacts, warranting further exploration and larger studies to validate these observations. Tailored interventions targeting fatigue, insomnia, and emotional well-being are crucial for improving QoL in this population. Trial RegistrationRegistered in January 2016 at ClinicalTrials.gov (ID: NCT02837679).

Frailty as a sequela of burn injury: a post hoc analysis of the “RE-ENERGIZE” multicenter randomized-controlled trial and the National Health Interview Survey

BackgroundWith advancements in burn treatment and intensive care leading to decreased mortality rates, a growing cohort of burn survivors is emerging. These individuals may be susceptible to frailty, characterized by reduced physiological reserve and increased vulnerability to stressors commonly associated with aging, which significantly complicates their recovery process. To date, no study has investigated burns as a potential risk factor for frailty. This study aimed to determine the short-term prevalence of frailty among burn survivors’ months after injury and compare it with that of the general population.MethodsA post hoc analysis was conducted on the Randomized Trial of Enteral Glutamine to Minimize the Effects of Burn Injury (RE-ENERGIZE) trial, an international randomized-controlled trial involving 1200 burn injury patients with partial- or full-thickness burns. Participants who did not complete the 36-Item Short Form Health Survey (SF-36) questionnaire were excluded. Data for the general population were obtained from the 2022 National Health Interview Survey (NHIS). Frailty was assessed using the FRAIL (Fatigue, Resistance, Ambulation, Illness, Loss of weight) scale. Due to lack of data on loss of weight, for the purposes of this study, malnutrition was used as the fifth variable. Illness and malnutrition were based on admission data, while fatigue, resistance, and ambulation were determined from post-discharge responses to the SF-36. The burn cohort and general population groups were matched using propensity score matching and compared in terms of frailty status. Within the burn group, patients were divided into different subgroups based on their frailty status, and the differences in their (instrumental) activities of daily living (iADL and ADL) were compared. A multivariable analysis was performed within the burn cohort to identify factors predisposing to frailty as well as compromised iADL and ADL.ResultsOut of the 1200 burn patients involved in the study, 600 completed the required questionnaires [follow-up time: (5.5 ± 2.3) months] and were matched to 1200 adults from the general population in the U.S. In comparison to the general population, burn patients exhibited a significantly higher likelihood of being pre-frail (42.3% vs. 19.8%, P < 0.0001), or frail (13.0% vs. 1.0%, P < 0.0001). When focusing on specific components, burn patients were more prone to experiencing fatigue (25.8% vs. 13.5%, P < 0.0001), limited resistance (34.0% vs. 2.7%, P < 0.0001), and restricted ambulation (41.8% vs. 3.8%, P < 0.0001). Conversely, the incidence rate of illness was observed to be higher in the general population (1.2% vs. 2.8%, P = 0.03), while no significant difference was detected regarding malnutrition (2.3% vs. 2.6%, P = 0.75). Furthermore, in comparison with robust burn patients, it was significantly more likely for pre-frail and frail patients to disclose compromise in ADL and iADL. The frail cohort reported the most pronounced limitation.ConclusionsOur findings suggest a higher incidence of post-discharge frailty among burn survivors in the short-term following injury. Burn survivors experience compromised fatigue, resistance, and ambulation, while rates of illness and malnutrition were lower or unchanged, respectively. These results underscore the critical need for early identification of frailty after a burn injury, with timely and comprehensive involvement of a multidisciplinary team including burn and pain specialists, community physicians, physiotherapists, nutritionists, and social workers. This collaborative effort can ensure holistic care to address and mitigate frailty in this patient population.

Frailty is Superior to Age at Predicting Extended Length of Stay and Immediate Postoperative Complications Following Total Wrist Arthrodesis

Abstract Hypothesis The modified five-factor frailty index (mFI-5) is a better predictor than age alone of increased risk of extended length of stay (LOS) and postoperative complications in patients undergoing total wrist arthrodesis (TWA). Methods The National Inpatient Sample database was queried for patients undergoing elective TWA. Patients were identified using the International Classification of Diseases, 10th Revision procedure codes, excluding nonelective cases, hardware removal, and patients with cerebral palsy or seizure disorders. Frailty was assessed by identifying the variables used in the mFI-5 and patients were categorized as nonfrail (mFI-5 = 0), prefrail (mFI-5 = 1), and frail (mFI-5 ≥ 2). Outcomes assessed included LOS and immediate postoperative complications such as nausea and vomiting requiring admission, acute kidney injury, postoperative hypotension, postoperative hypothyroidism, and urinary tract infection. Logistic regression was used to analyze the association between frailty status and both extended LOS and immediate postoperative complications. Results Between 2015 and 2019, 685 patients underwent TWA, with 49.6% not frail, 33.5% prefrail, and 16.7% frail. Prefrail and frail patients were at increased risk of undergoing extended LOS (OR 2.182, p = 0.001; OR 2.312, p = 0.002, respectively). Age over 65 (OR 1.995, p &lt; 0.001) and female sex (OR 1.605, p = 0.029) were also independent risk factors. Frail patients were found to have an increased likelihood of acquiring any postoperative complication (OR 3.865, p &lt; 0.001), while elderly age was not a significant risk factor (OR 1.361, p = 0.298). Using receiver operating characteristic (ROC) curve analysis, the mFI-5 demonstrated superior discriminatory ability compared with age for extended LOS (Area under the curve (AUC) 0.729 vs. 0.542) and postoperative complications (AUC 0.712 vs. 0.673). Conclusion Our study demonstrates that both elderly age and frailty are independent predictors of extended hospitalization following TWA, while frailty but not age, is a significant predictor of immediate postoperative complications. To our knowledge, our study is the first to report an association between frailty status and immediate postoperative complications following TWA. Incorporating a preoperative frailty screening can allow for more open and informed preoperative discussion about surgical risk for elective procedures such as TWA, as well as allow for enhanced postoperative planning.

Frailty and all-cause and cancer-related mortality in cancer patients: A prospective cohort study

PurposeTo evaluate the associations between frailty and all-cause and cancer-related mortality. Additionally, the objective is to compare the magnitude of these associations between older adults and younger adults. MethodsWe gathered baseline data from NHANES (1999–2018) and developed a cumulative index consisting of 39 items to evaluate frailty. The National Death Index database was utilized to track the survival status of individuals. The Cox regression model was employed to estimate the associations between frailty status and all-cause and cancer-related mortality. ResultsUltimately, 3398 cancer patients were included in the analysis, comprising 910 younger adults and 2488 older adults. Compared to non-frail patients, the elevated all-cause and cancer-related mortality among pre-frail patients was not statistically significant (HRs = 1.312, 95%CI: 0.956–1.800, P = 0.092; HRs = 1.462, 0.811–2.635, P = 0.207). However, a significant elevation of both all-cause and cancer-related mortality risk was observed among frail patients (HRs = 2.213, 1.617–3.030, P < 0.001; HRs = 2.463, 95%CI = 1.370–4.429, P = 0.003). Frailty individuals demonstrated a more pronounced association with the prediction of all-cause mortality in younger (HRs = 2.230, 1.073–4.634, P = 0.032) than in older adults (HRs = 2.090, 1.475–2.960, P < 0.001). Sensitivity analysis consistently revealed robust results. RCS plots suggested a progressively escalating dose-response correlation between frailty and both all-cause and cancer-related mortality risk. ConclusionsPre-frailty did not result in an increase in mortality risks compared to non-frailty. However, frailty caused a higher all-cause and cancer-related mortality risk than non-frailty. Identifying those at risk and implementing targeted interventions may contribute to extending healthy life expectancy, regardless of age.

Geriatric assessment with management for older patients with cancer receiving radiotherapy: a cluster-randomised controlled pilot study

BackgroundGeriatric assessment and management (GAM) improve outcomes in older patients with cancer treated with surgery or chemotherapy. It is unclear whether GAM may provide better function and quality of life (QoL), or be cost-effective, in a radiotherapy (RT) setting.MethodsIn this Norwegian cluster-randomised controlled pilot study, we assessed the impact of a GAM intervention involving specialist and primary health services. It was initiated in-hospital at the start of RT by assessing somatic and mental health, function, and social situation, followed by individually adapted management plans and systematic follow-up in the municipalities until 8 weeks after the end of RT, managed by municipal nurses as patients’ care coordinators. Thirty-two municipal/city districts were 1:1 randomised to intervention or conventional care. Patients with cancer ≥ 65 years, referred for RT, were enrolled irrespective of cancer type, treatment intent, and frailty status, and followed the allocation of their residential district. The primary outcome was physical function measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Secondary outcomes were overall quality of life (QoL), physical performance, use and costs of health services. Analyses followed the intention-to-treat principle. Study registration at ClinicalTrials.gov ID NCT03881137.ResultsWe included 178 patients, 89 in each group with comparable age (mean 74.1), sex (female 38.2%), and Edmonton Frail Scale scores (mean 3.4 [scale 0–17], scores 0–3 [fit] in 57%). More intervention patients received curative RT (76.4 vs 61.8%), had higher irradiation doses (mean 54.1 vs 45.5 Gy), and longer lasting RT (mean 4.4 vs 3.6 weeks). The primary outcome was completed by 91% (intervention) vs 88% (control) of patients. No significant differences between groups on predefined outcomes were observed. GAM costs represented 3% of health service costs for the intervention group during the study period.ConclusionsIn this heterogeneous cohort of older patients receiving RT, the majority was fit. We found no impact of the intervention on patient-centred outcomes or the cost of health services. Targeting a more homogeneous group of only pre-frail and frail patients is strongly recommended in future studies needed to clarify the role and organisation of GAM in RT settings.

Predictive Value of Modified Frailty Index, Sarcopenia, Prognostic Nutritional Index, and Geriatric Nutritional Risk Index for Postoperative Complications in Oblique Lumbar Interbody Fusion Over 60 Years

ObjectiveElderly patients undergoing spinal surgery are at an increased risk of morbidity and mortality. Evaluating frailty and preoperative status is crucial for predicting postoperative outcomes. This study aimed to assess the predictive value of the modified Frailty Index (mFI), sarcopenia, Prognostic Nutritional Index (PNI) and Geriatric Nutritional Risk Index (GNRI) in determining postoperative complications in patients undergoing oblique lumbar interbody fusion (OLIF) over 60 years. MethodsPreoperative risk factors were assessed using 11 variables, including mFI, PNI, GNRI. Complication rates were compared among nonfrail (mFI = 0; n = 50), prefrail (mFI = 0.09–0.18; n = 144), and frail (mFI ≥0.27; n = 80) patients. Demographic and perioperative variables were compared between the complication and noncomplication groups. The incidence of complications was the primary outcome measure. ResultsComplications occurred in 36 of 274 patients (13.1%). The frail group exhibited a significantly higher incidence of pneumonia than the nonfrail and prefrail groups. The complication group displayed significant differences in several variables, including age, fusion level, albumin level, lymphocyte count, platelet count, creatinine level, and estimated blood loss. Moreover, mFI, PNI, and GNRI differed significantly between the complication and noncomplication groups. ConclusionMFI, PNI, and GNRI can be useful for predicting postoperative morbidity and mortality in patients undergoing OLIF. These comprehensive assessment methods enable the identification of high-risk patients and the formulation of tailored strategies to enhance postoperative outcomes. Integrating mFI, PNI, and GNRI into the preoperative evaluation process can help healthcare providers proactively manage high-risk patients, thus improving the overall quality of care for elderly individuals undergoing OLIF.

Does frailty affect barriers to physical activity in patients with symptomatic peripheral artery disease? A cross-sectional study

BackgroundFrailty syndrome is prevalent among many patients experiencing intermittent claudication symptoms. Considering that components of the frailty syndrome can affect both physical and psychological functions, it is likely that barriers to physical activity are heightened in these individuals. AimTo analyze the association between barriers to physical activity and frailty in patients with symptomatic peripheral artery disease (PAD). MethodsThis cross-sectional study included 216 patients with symptomatic PAD (64.8% men, 65.6±9.4 yrs.). Nine personal and 8 environmental barriers to physical activity were investigated through a questionnaire on barriers to practicing physical activity in patients with intermittent claudication. Frailty was defined according to Fried et al. (2001) criteria which included unintentional weight loss, exhaustion, low grip strength, slow walking speed, physical inactivity. Three or more criteria defined frail, one or 2 criteria defined pre-frail, and absence of criteria defined non-frail. Data are presented as median (interquartile range). ResultsFrail and pre-frail patients have more barriers than non-frail patients [frail: 11 (4); pre-frail: 10 (6); non-frail: 8 (7), p = 0.001]. Absence of a companion for physical activity, lack of knowledge and uncertainty about the benefits of physical activity, pain induced by walking and presence of obstacles that worsen leg pain were associated with frail and pre-frail status, independent of sex, age, ankle-brachial index, and total walking distance. ConclusionPatients with PAD who are frail and pre-frail have more barriers to physical activity than non-frail patients. Therefore, specific interventions promoting PA are essential for these patients to improve their health outcomes.

Association of Fried’s frailty phenotype, but not the clinical frailty scale, with overall survival in older adults with acute myeloid leukemia.

e23222 Background: Frailty is a geriatric syndrome marked by increased vulnerability to stressors. “Fitness,” is utilized to guide treatment in acute myeloid leukemia (AML) where the intensity of initial induction may be high (anthracycline and cytarabine-based), intermediate (venetoclax combinations), or low (single hypomethylating agent or targeting therapy). Fried’s Frailty Phenotype (FP) combines subjective (self-reported exhaustion, weight loss &gt; 5%, activity level) and objective (4-meter walk speed and grip strength) measures to categorize patients into fit, pre-frail, and frail. In prior work, we demonstrated an association of FP with survival for newly diagnosed older adults with AML. Clinical Frailty Scale (CFS) is a purely subjective score that utilizes chart data to stratify the degree of fitness. The incorporation of objective measures into clinical practice is limited due to time constraints, we sought to determine if CFS could similarly identify frailty and risk-stratify older adults with AML. Methods: Eighty-three patients 60 years or older with a new diagnosis of AML were enrolled on an IRB approved study from September, 2018 to May, 2023 at the Hospital of the University of Pennsylvania. FP was performed prior to initiation of therapy. A CFS certified trainee blinded to FP scores retrospectively reviewed electronic medical records to assign a CFS score. CFS was collapsed into variations defined as CFS fit (1-3), pre-frail (4), and frail (5 or greater); CFS Collapse 1 fit (1-2), pre-frail (3-4), and frail (5 or greater), and CFS Collapse 2 fit (1-4) and mild to moderately frail (5-6). Variations were based on the scale’s descriptions and literature. Results: Median patient age was 71 (range 60-91) years. By European LeukemiaNet 2017, 64% of patients had adverse-risk AML. 39% of patients received IC, 52% received HMA/ven, 6% received HMA alone or targeted therapy, and 2% received supportive care. By FP, 18% were fit, 38% were pre-frail, and 45% were frail. FP was significantly associated with OS (p = 0.047): 2-year OS was 57%, 42%, and 21% in fit, pre-frail, and frail. By CFS, 43% were fit, 32% pre-frail, and 24% frail. CSF was not significantly associated with OS (p = 0.495); 2-year OS was 24%, 35%, and 19% for fit, pre-frail, and frail patients, respectively. CSF collapse 1 (p = 0.249) and 2 (p = 0.070) were not significant. Conclusions: FP identified more patients as frail and was associated with a doubling of early mortality and inferior 2-year OS. CFS identified more patients as fit and was not associated with 2-yr OS. The discrepancy emphasizes the importance of objective measurements to capture frailty and the difficulty in determining frailty based on chart reviews in an acutely ill population. Future work to streamline objective measurements in frailty assessments to increase utilization in clinics given its likely importance for accurate risk-stratification.

The Impact of Frailty Components and Preoperative Mechanical Cardiac Support Changes with Time after Heart Transplantation.

Frailty has been proven to be associated with mortality after orthotopic heart transplantation (OHT). The aim of our study was to determine the impact of frailty on mortality in the current era using pretransplant mechanical cardiac support (MCS). We retrospectively calculated the frailty scores of 471 patients undergoing OHT in a single institution between January 2012 and August 2022. The outcome was all-cause mortality. The median survival time was 1987 days (IQR: 1487 days) for all patients. In total, 266 (56.5%) patients were categorized as nonfrail, 179 (38.0%) as prefrail, and 26 (5.5%) as frail. The survival rates were 0.73, 0.54, and 0.28 for nonfrail, prefrail, and frail patients, respectively. The frailty score was associated with mortality [HR: 1.34 (95% CI: 1.22-1.47, p < 0.001)]. Among the components of the frailty score, age above 50 years, creatinine ≥ 3.0 mg/dL or prior dialysis, and hospitalization before OHT were independently associated with mortality. Continuous-flow left ventricular assist devices (CF-LVAD) were associated with an increased risk for all-cause mortality [AHR: 1.80 (95% CI: 1.01-3.24, p = 0.047)]. The components of the frailty score were not equally associated with mortality. Frailty and pretransplant MCS should be included in the risk estimation.

Home exercise, branched-chain amino acids, and probiotics improve frailty in cirrhosis: A randomized clinical trial.

Frailty is a predictive factor of hospitalization, falls, and mortality in patients with cirrhosis, regardless of the degree of liver failure. The aim was to analyze whether a multifactorial intervention consisting of home-based exercise, branched-chain amino acids, and a multistrain probiotic can improve frailty in these patients. Outpatients with cirrhosis were classified according to the Liver Frailty Index (LFI). Prefrail and frail patients were randomized into 2 groups. The intervention group was assigned to a multifactorial intervention consisting of exercise at home, branched-chain amino acid supplements, and a multistrain probiotic for 12 months. The control group received standard care. All patients were prospectively followed up every 3 months for 1 year to determine LFI, incidence of falls, emergency room visits, hospitalizations, and mortality. Thirty-two patients were included: 17 patients were assigned to the intervention group and 15 to the control group. In the intervention group, the baseline LFI decreased at 3, 6, 9, and 12 months (p = 0.019 for overall change with respect to the control group). The change in LFI (ΔLFI) at 12 months was -0.71 ± 0.24 in the intervention group and -0.09 ± 0.32 in the control group (p<0.001). During follow-up, patients in the intervention group had a lower 1-year probability of falls (6% vs. 47%, p = 0.03) and emergency room visits (10% vs. 44%, p = 0.04) than patients in the control group. A long-term multifactorial intervention that included exercise at home, branched-chain amino acids, and a multistrain probiotic improved frailty in outpatients with cirrhosis and was associated with a decrease in the incidence of clinical events such as falls and emergency room visits.

Post-COVID-19 patients in geriatric rehabilitation substantially recover in daily functioning and quality of life.

After an acute infection, older persons may benefit from geriatric rehabilitation (GR). This study describes the recovery trajectories of post-COVID-19 patients undergoing GR and explores whether frailty is associated with recovery. Multicentre prospective cohort study. 59 GR facilities in 10 European countries. Post-COVID-19 patients admitted to GR between October 2020 and October 2021. Patients' characteristics, daily functioning (Barthel index; BI), quality of life (QoL; EQ-5D-5L) and frailty (Clinical Frailty Scale; CFS) were collected at admission, discharge, 6weeks and 6months after discharge. We used linear mixed models to examine the trajectories of daily functioning and QoL. 723 participants were included with a mean age of 75 (SD: 9.91) years. Most participants were pre-frail to frail (median [interquartile range] CFS 6.0 [5.0-7.0]) at admission. After admission, the BI first steeply increased from 11.31 with 2.51 (SE 0.15, P< 0.001) points per month and stabilised around 17.0 (quadratic slope: -0.26, SE 0.02, P< 0.001). Similarly, EQ-5D-5L first steeply increased from 0.569 with 0.126 points per month (SE 0.008, P< 0.001) and stabilised around 0.8 (quadratic slope: -0.014, SE 0.001, P< 0.001). Functional recovery rates were independent of frailty level at admission. QoL was lower at admission for frailer participants, but increased faster, stabilising at almost equal QoL values for frail, pre-frail and fit patients. Post-COVID-19 patients admitted to GR showed substantial recovery in daily functioning and QoL. Frailty at GR admission was not associated with recovery and should not be a reason to exclude patients from GR.

The 5-factor modified frailty index as a prognostic factor of stereotactic radiosurgery for metastatic disease to the brain.

Frailty, a state of increased vulnerability to adverse health outcomes, is associated with poor neurosurgical outcomes. The relationship between frailty and stereotactic radiosurgery (SRS) for brain metastases (BMs), however, has not been adequately described. In this study, the authors attempted to examine the connection between frailty and outcomes for patients receiving SRS for BMs. A single-center retrospective cohort study was performed. The 5-factor modified frailty index (mFI-5) was used to stratify patients into pre-frail (mFI-5 score 0-1), frail (mFI-5 score 2), and severely frail (mFI-5 score ≥ 3) cohorts at the time of SRS treatment. Both overall survival (OS) and progression-free survival (PFS) were evaluated. Factors associated with OS/PFS were assessed using Kaplan-Meier analysis and a Cox proportional hazards model. Two hundred three patients met the inclusion criteria and received SRS to one or more BMs. Fifty-six patients (27.6%) received SRS as an adjuvant treatment. The 12-month OS and PFS rates were 58.6% and 45.5%, respectively. One hundred twenty-six patients (62.1%) were classified as pre-frail, 58 (28.6%) as frail, and 19 (9.4%) as severely frail. Significantly less OS was demonstrated in frailer groups (frail hazard ratio [HR] 3.14, p < 0.005; severely frail HR 3.13, p < 0.005). Compared with pre-frail patients, frail patients had shorter intervals of PFS (frail HR 2.05, p < 0.005). Five patients (2.5%) had symptomatic radiation necrosis (RN) and 60 (29.6%) required repeat radiation. Higher frailty scores at the time of SRS treatment were predictive of shorter OS and PFS intervals.

Prognostic impact of frailty based on a comprehensive frailty assessment in patients with heart failure.

This study aimed to evaluate the impact of frailty and living function domains based on the Kihon Checklist (KCL), a questionnaire for a comprehensive frailty assessment, on prognosis in patients with acute heart failure (AHF). The Kochi Registry of Subjects with Acute Decompensated Heart Failure (Kochi YOSACOI) study was a prospective multicentre cohort study enrolling 1061 patients hospitalized for AHF from May 2017 to December 2019 in Japan. We divided patients into three groups according to the severity of frailty using the KCL and compared clinical outcomes after discharge. The primary endpoint was all-cause death, and the secondary outcomes were cardiovascular death, heart failure (HF) rehospitalization, and the composite event of cardiovascular death and HF rehospitalization. Of 936 patients (median age, 81years; 48.9% women) who could be assessed for frailty, we identified frailty in 501 patients (53.5%), prefrailty in 290 patients (31.0%), and non-frailty in 145 patients (15.5%). Compared with prefrail and non-frail patients, frail patients were older (83 vs. 79 and 72years, P<0.001), were more likely to be women (53.9% vs. 43.1% and 43.4%, P=0.005), and were more likely to have a history of previous HF hospitalization (35.4% vs. 25.3% and 19.6%, P<0.001) and multimorbidity (90.8% vs. 81.0% and 73.8%, P<0.001). Frail patients had a lower rate of discharge to home (79.7% vs. 94.8% and 96.5%, P<0.001). During the 2year follow-up period, frail patients had a higher incidence rate of all-cause death, cardiovascular death, and HF rehospitalization (log-rank P<0.001, P<0.001, and P=0.003, respectively). After adjusting for other prognostic factors, multivariate analysis showed that frailty was associated with all-cause death [adjusted hazard ratio (HR): 2.917, 95% confidence interval (CI): 1.326-6.417, P=0.008] and cardiovascular death (adjusted HR: 7.026, 95% CI: 1.700-29.030, P=0.007). Among all domains of the KCL, the cognitive function domain was associated with a higher risk of all-cause death (P=0.004) and cardiovascular death (P<0.001). The depression domain remained associated with a higher risk of HF rehospitalization (P=0.045). The risk for all-cause death increased with an increase in total KCL score (adjusted HR: 1.819, 95% CI: 1.300-2.547, P<0.001). The KCL is a useful tool for risk stratification of adverse outcomes in patients with AHF. Functional declines in psycho-emotional domains including cognitive function and depressed mood contribute to adverse outcomes.